Comparison between arthroscopic and open synovectomy for the knee in rheumatoid arthritis

Summary Ten surgical anterior capsulosynovectomies following Mori's four-block capsular incision technique in nine rheumatoid patients and 14 arthroscopic synovectomies utilizing a Wolf arthroscope with a large pituitary rongeur or a motorized intraarticular shaver in 11 patients were performed in our department. In three patients with bilateral involvement at nearly the same stage (III), we operated on the knees simultaneously, using open capsulosynovectomy on one side and arthroscopic synovectomy on the other side; we comparatively assessed the postoperative course, the subjective evaluation of the patients, and the follow-up results. Surgical intervention is milder in the arthroscopic operation, and post-operative knee pain during motion exercise is markedly less in the arthroscopically synovectomized knee. Although the postoperative management was more complex for open capsulosynovectomized knees, the results obtained at 1–2 months after synovectomy showed no significant difference between the two procedures.     

Simple prognostic markers for optimal treatment of patients with unresectable pancreatic cancer

Most patients with pancreatic cancer are ineligible for curative resection at diagnosis, resulting in poor prognosis. This study aimed to evaluate the prognostic factors in patients with unresectable pancreatic cancer.We retrospectively collected clinical data from 196 patients with unresectable pancreatic cancer who received palliative chemotherapy (N = 153) or palliative care alone (N = 43) from January 2011 to December 2013. Patients’ background data and overall survival were analyzed using the Cox proportional hazard regression model.In patients receiving palliative chemotherapy (gemcitabine-based regimen, 88.2%) and palliative care alone, the median (range) ages were 68 (43–91) and 78 (53–90) years, and metastatic diseases were present in 80% (N = 123) and 86% (N = 37), respectively. Multivariate analysis in the palliative chemotherapy patients showed that liver metastasis (hazard ratio [HR] 2.25, 95% confidence interval [CI] 1.58–3.20, P < .001), neutrophil-to-lymphocyte ratio (>4.5 vs ≤4.5; HR 3.45, 95% CI 2.22–5.36, P < .001), and cancer antigen 19-9 (CA19-9) (≥900 vs <900 U/mL; HR 1.45, 95% CI 1.02–2.05, P = .036) were independent prognostic factors. In those receiving palliative care alone, lung (HR 3.27, 95% Cl 1.46-7.35, p = 0.004) and peritoneum (HR 2.50, 95% CI 1.20–5.18, P = .014) metastases and the C-reactive protein-to-albumin ratio (≥1.3 vs <1.3; HR 3.33, 95% Cl 1.51–7.35, P = .003) were independent prognostic factors. Furthermore, patients with multiple factors had worse prognosis in both groups. Median survival time of palliative chemotherapy patients with risk factors 0, 1, 2, and 3 were 13.1 (95% CI 8.0–16.9), 9.4 (95% CI 7.9–10.1), 6.6 (95% CI 4.9–7.8), and 2.5 (95% CI 1.7–4.0) months, respectively. Similarly, median survival time was 5.7 (95% CI 1.3 -8.0), 2.1 (95% CI 1.5–3.9), and 1.3 (95% CI 0.6–1.7) months, respectively, for palliative care alone patients with risk factor 0, 1, and 2 to 3.Prognostic markers for pancreatic cancer were neutrophil-to-lymphocyte ratio, liver metastasis, and CA19-9 in patients undergoing palliative chemotherapy and C-reactive protein-to-albumin ratio and lung/peritoneum metastases in patients undergoing palliative care alone. These simple markers should be considered when explaining the prognosis and therapeutic options to patients.     

Administration of the Rho-Kinase Inhibitor Fasudil Before Ischemia or just After Reperfusion,but not 30 min After Reperfusion,Protects the Stunned Myocardium in Swine

OBJECTIVES: We assessed the effect of administration time for fasudil treatment of the stunned myocardium in 40 anesthetized open chest swine. MATERIALS AND METHODS: All swine were subjected to 12 min ischemia followed by reperfusion to generate stunned myocardium. Group A (n = 11) received saline in place of fasudil both before ischemia and after reperfusion. Group B (n = 10) received 30 min intravenous fasudil at a rate of 13 mug/kg/min starting 45 min before ischemia and received saline after reperfusion. Groups C (n = 10) and D (n = 9) received saline before ischemia, and received fasudil at a rate of 13 mug kg(-1) min(-1) starting just before reperfusion in group C and 30 min after reperfusion in group D. In both groups, treatment lasted 30 min. Myocardial contractility was assessed by percent segment shortening (%SS). RESULTS AND DISCUSSION: Three swine in group A, 2 swine in each of groups B and C, and one swine in group D had ventricular fibrillation or tachycardia after reperfusion and were excluded from further analysis. The changes of %SS from baseline at 90 min after reperfusion in groups B and C were 68 +/- 8% and 75 +/- 8%, respectively, which were significantly higher than in group A or D (47 +/- 10% or 43 +/- 8%). CONCLUSION: We conclude that fasudil administered before ischemia or just after reperfusion, but not 30 min after reperfusion, protects the stunned myocardium.     

Placental system A amino acid transport is reduced in pregnancies with small for gestational age (SGA) infants but not in preeclampsia with SGA infants

Preeclampsia and intrauterine growth restriction (IUGR) are both associated with abnormal remodeling of maternal spiral arteries perfusing the placental site. This would be expected to be associated with reduced fetal growth, yet only one third of infants of mothers with preeclampsia are growth restricted. Infants with IUGR have decreased concentrations of amino acids in their blood and system A amino acid transporter activity is reduced in their placentas. Since infants of preeclamptic pregnancies have increased circulating amino acids, we tested system A amino acid transport activity of placental villous fragments from pregnancies with small for gestational age (SGA) infants with and without maternal preeclampsia and from uncomplicated and preeclamptic pregnancies with normal sized infants. We confirm the reduced uptake of amino acids in SGA pregnancies without preeclampsia but report that placental amino acid uptake of SGA infants with maternal preeclampsia is not reduced and is identical to uptake by normal and preeclamptic pregnancies with normal weight infants.     

The role of drinking and cigarette smoking in the excess deaths from liver cancer

A long-term cohort study of 639 males in a farming area and 677 males in a fishing area in Kyushu, Japan, has been conducted to evaluate risk factors for ischemic heart disease. The present investigation utilized this long-term cohort study to assess the role of drinking and cigarette smoking habits in the causation of liver cancer. The O/E ratio (ratio of the observed to expected number of deaths) of liver cancer was 7.5 (P less than 0.001) among shochu drinkers in the fishing area. Further, a clear dose-response relationship of O/E ratio was noted: 5.7 (P less than 0.001), 7.5 (P less than 0.001) and 20.0 (P less than 0.001) for drinkers of less than 1, 1-2, and 2 or more units of shochu (a distilled alcoholic beverage made in Japan; about 25% alcohol). Although no excess risk was found among shochu drinkers in the farming area, observed and expected numbers were too small to make valid judgements. Among sake drinkers, the observed and expected numbers were very similar in both areas. Cigarette smokers in the fishing area appeared to have a high risk for liver cancer, the O/E ratio being 4.8 (P less than 0.001). However, there was no clear dose-response relationship and O/E ratios among cigarette smokers according to their drinking habits indicated no excess risk among nondrinkers. A multiple logistic regression analysis showed an insignificant effect of cigarette smoking on the development of liver cancer after adjustment for shochu drinking. These findings suggest a significant involvement of shochu drinking in the etiology of liver cancer, at least in this fishing area.     

Falls in the institutionalized elderly in Japan

Falls can be considered a vital factor in impeding successful aging in the elderly. The purpose of the study is to know rates of falls per year among the elderly, to observe the situations when falls occurred, and to clarify the association of falls with physical deterioration. The survey was carried out in 1406 residents aged 65 and over of the Tokyo Metropolitan Home for the Elderly in 1982. The rate of subjects who fell more than once during a one-year period was 14.5%. Females had a higher rate than males. Sixty per cent of all the falls occurred indoors. As for the cause of the falls, extrinsic factors were accounted three times as much as intrinsic factors. Among injuries sustained by the falls, fracture was more frequent in females than in males. Length of time of standing on one leg was shorter for fallers than for non-fallers in both sexes. However, the differences were not significant when age was controlled. Fall is attributed not only to physical factors but also to environmental factors. Therefore, it should be encouraged to design an environment with devices.